Sinusitis

Topic Overview

What is sinusitis?

Sinus infections
often follow a cold and cause pain and pressure in your head and face.

Sinusitis can be either acute (sudden) or chronic (long-term). With
chronic sinusitis,
the infection or inflammation does
not completely go away for 12 weeks or more.

What causes sinusitis?

Sinusitis can be caused by
three things:

Viruses.

Bacteria.

Fungi.

The same viruses that cause the common cold cause most
cases of sinusitis.

When the lining of the sinus cavities gets
inflamed from a viral infection like a cold, it swells. This is viral
sinusitis. The swelling can block the normal drainage of fluid from the sinuses
into the nose and throat. If the fluid cannot drain and builds up over time,
bacteria or fungi (plural of fungus) may start to grow in it. These bacterial
or fungal infections can cause more swelling and pain. They are more likely to
last longer, get worse with time, and become chronic.

Nasal
allergies or other problems that block the nasal passages and allow fluid to
build up in the sinuses can also lead to sinusitis.

What are the symptoms?

The main symptoms of
sinusitis are a runny or stuffy nose and pain and pressure in your head and
face. You may also have a yellow or green
drainage or drip from your nose or down the back of
your throat (postnasal discharge). Where you feel the pain and tenderness
depends on which sinus is affected.

Other common symptoms of
sinusitis may include:

A headache.

Bad
breath.

A cough that produces
mucus.

A fever.

Pain in your
teeth.

A reduced sense of taste or smell.

How is sinusitis diagnosed?

Your doctor can tell
if you have sinusitis by asking questions about your past health and doing a
physical exam. You probably won't need any other tests.

How is it treated?

Viral sinus infections usually
go away on their own within 10 to 14 days. Antibiotics don't work for viral
infections. But there are some things you can do at home to help relieve your
symptoms:

Drink plenty of fluids.

Put a
hot, damp towel or gel pack on your face for 5 to 10 minutes at a time, several
times a day.

Breathe warm, moist air from a steamy shower, a hot
bath, or a sink filled with hot water.

Use saline nose drops and sprays to keep the nasal passages moist and use saline nasal washes to help keep the nasal passages
open and wash out mucus and bacteria.

Try
over-the-counter medicine to help relieve pain and pressure in your head and face.

Home treatments may help drain mucus from the sinuses and
prevent a more serious bacterial or fungal infection.

Bacterial
infections can be treated with antibiotics. You will probably feel better in a
few days, but some symptoms may last for several weeks. You may need to take
the medicine for a longer time if you have chronic sinusitis.

If
you have a
fungal infection-which is not common-antibiotics won't
clear up your sinusitis. With this type of infection, you may need treatment
with antifungal medicines,
steroid medicines, or surgery.

If you
have taken antibiotics and other medicines for a long time but still have
sinusitis symptoms, you may need surgery. You may also need surgery if the
infection is likely to spread or if you have other problems, such as a growth
(polyp) blocking the nasal passage.

Cause

Sinusitis is
most often the result of a
viral infection that causes the
mucous membrane lining the inside of the nose and the
sinuses to become
inflamed.

The mucous membrane swells when it becomes
inflamed, blocking the drainage of fluid from the sinuses into the nose and
throat.

Mucus and fluid build up inside the
sinuses, causing pressure and pain.

Bacteria are more likely to
grow in sinuses that are unable to drain properly.
Bacterial infection in the sinuses often causes more
inflammation and pain.

Colds usually trigger this process, but any factor that
causes the mucous membrane to become inflamed may lead to sinusitis. Many
people with nasal allergies (allergic rhinitis), for instance, are
likely to have recurring or long-term (chronic) sinus infections. Nasal
polyps, foreign objects (usually in children),
structural problems in the nose such as a
deviated septum, and other conditions can also block
the nasal passages, increasing the risk of sinusitis.

Symptoms

Pain and pressure in the face along with a
stuffy or runny nose are the main symptoms of
sinusitis. You also may have a yellow or greenish
discharge from your nose. Leaning forward or moving your head often increases
facial pain and pressure.

The location of pain and tenderness may depend on
which sinus is affected.

Other common symptoms of sinusitis include:

Headache.

Yellow or greenish
discharge from the nose or down the back of the throat.

Bad
breath.

Stuffy nose.

Cough that produces
mucus.

Fever.

Tooth
pain.

Reduced sense of taste or smell.

Acute (sudden) sinusitis is usually caused by a
viral infection and often develops rapidly. It usually
lasts for 4 weeks or less, and the symptoms often begin to clear up within a
week without any treatment. Acute sinusitis caused by a
bacterial infection is less likely to clear up on its
own and may lead to chronic sinusitis or to complications in which the
infection spreads beyond the sinuses. Nasal discharge that contains pus and
gets worse after 5 days or persists for more than 10 days may be a sign
of acute sinusitis caused by a bacterial infection.

Chronic
(long-term) sinusitis is usually caused by a bacterial or
fungal infection. These infections may be difficult to
treat. If chronic sinusitis is not cured after trying two or more different
antibiotics, you may want to talk with your doctor about surgery
or allergy testing. Chronic sinusitis can lead to permanent changes in the
mucous membranes that line the sinuses and may make
you more prone to sinus infections.

Symptoms of sinusitis in
children include coughing, nasal discharge that lasts more than 7 to 10 days,
and complaints of headache and facial pain. Many children age 2 or older with
chronic sinusitis may also have allergies and frequent ear infections.

Other conditions that have symptoms similar to sinusitis may include allergies, toothaches, and
colds or other
upper respiratory infections. But if you've had a cold
that returns or gets worse after 7 days, you may have a sinus infection rather than a cold or other upper respiratory
infection.

What Happens

There are two types of
sinusitis: acute (sudden onset) and chronic
(long-term). Sinusitis often develops after a cold or
viral infection. Most sinus infections improve on
their own, but sometimes they develop into a
bacterial infection-swelling, inflammation, and
mucus production caused by the cold can lead to
blockage in the nasal passages, which may encourage the growth of
bacteria.

Acute sinusitis, whether viral or bacterial, may develop
into chronic inflammation or infections that may last 12 weeks or longer.
Chronic sinusitis can lead to permanent changes in the
mucous membranes that line the sinuses. As a result of
these changes, you may become prone to having more sinus infections that may
become more difficult to treat.

Complications of sinusitis (such as an infection of the facial bones called
osteomyelitis) or meningitis are relatively rare. But when
complications occur, they may be life-threatening and often require extensive
medical or surgical treatment.

What Increases Your Risk

Your risk of sinusitis increases if you have recently had a cold,
another
viral or
bacterial infection, or an
upper respiratory tract infection. Also, chronic nasal
allergies (allergic rhinitis) can lead to sinusitis.

Sometimes a
deviated septum, broken nose, or growths such as
nasal polyps can make you more susceptible to sinus
infections. Problems with nasal structure can prevent the proper flow of
mucus from the sinuses into the nose.

Other factors that increase your risk for getting sinus infections
include having asthma, smoking, air pollution, overuse of decongestant sprays, cold weather,
rapid air pressure changes (such as from flying or scuba diving), and swimming
in contaminated water. Also, using
continuous positive airway pressure (CPAP) to treat
sleep apnea may increase the risk of sinusitis.

When To Call a Doctor

Call your doctor if
sinusitis does not improve after 2 days of home
treatment and you have symptoms such as:

Pain in the face or upper
teeth.

Pain extending from the bridge of the nose to the lower
eyelid.

Headache that is not relieved by an over-the-counter pain medicine, such as acetaminophen or ibuprofen.

Fever of
101°F (38.3°C) or
higher.

Nasal discharge that starts out clear and later becomes
thick and discolored (yellow or green).

Cold symptoms that last longer than 10 days or
get worse after the first 7 days.

Mild or chronic pain in the
face that lasts longer than a month, has changed, or has not been checked by a
doctor.

Not feeling any better within 3 to 5 days after starting antibiotics for your sinus infection.

Watchful waiting

Watchful waiting is appropriate if you have
symptoms of an early sinus infection (such as pain and pressure in your head
along with a stuffy or runny nose). An early sinus infection can often be
treated at home if you are in good health. If you develop symptoms of a sinus
infection, start home treatment, such as drinking lots of fluids and breathing
steam from a warm shower, and use the guidelines above to decide whether you
need to call a doctor.

Who to see

Sinusitis may be
diagnosed by any of the following health professionals:

Your doctor may refer you to an
ear, nose, and throat (ENT) specialist (also called an
otolaryngologist) who can provide a more specialized
examination of the nasal passages and upper throat. Referral to an ENT
specialist may be beneficial for people in whom nasal polyps or other
conditions causing blockage of the nasal cavity are suspected. Diagnosis and
surgical treatment of chronic or complicated cases of sinusitis may be done by
an ENT specialist.

An
infectious disease specialist may be needed when
sinusitis is caused by something unusual or when rare
complications (such as an infection of the facial
bones) occur. An
allergist may be needed when allergies are suspected
to be causing or contributing to sinus problems.

Exams and Tests

Diagnosis of
sinusitis is usually based on your
medical history and
physical exam. A detailed history of the
problem often can be of more value to the diagnosis than a physical exam. If
the symptoms and physical findings are typical of sinusitis, further testing is
usually not needed.

Additional tests may be done if:

The diagnosis is not
clear.

Antibiotic treatment has failed to clear up the
problem.

Complications (such as a bone infection) are
suspected.

Surgery is being considered.

Imaging tests may be used when symptoms of sinusitis
persist or recur despite treatment, or to look for tumors or other growths when
there is bleeding or bloody discharge from the nose. They include:

Computed tomography (CT) scan of the head and face , which provides a detailed image of sinus
structures. A CT scan may help evaluate severe or chronic sinusitis, identify
suspected complications of sinusitis, or rule out other conditions. It is not
used to diagnose acute sinusitis.

Sinus X-ray , which
may be done to confirm a suspected case of sinusitis. An X-ray produces a
picture of dense tissues inside the body. But a CT scan provides better
information.

Less often, other tests may be done by an ear, nose, and
throat (ENT) specialist (also called an otolaryngologist) or by an
allergist. These tests may include:

An
endoscopic sinus exam (ESM) (nasal endoscopy). An ESM
uses a lighted viewing instrument called an
endoscope to view structures inside your nose and
sinus cavities. ESM is used to evaluate chronic sinusitis.

Magnetic resonance imaging (MRI) . An MRI may be done
if there is reason to believe that an infection has spread beyond the sinuses.
It is also helpful in evaluating growths or tumors inside the nose or
sinuses.

Treatment Overview

Sinusitis is treated with
medicines and
home treatment, such as applying moist heat to
your face. The goals of treatment for
sinusitis are to:

Improve drainage of mucus and reduce swelling
in the sinuses.

Relieve pain and pressure.

Clear up any
infection.

Prevent the formation of scar tissue, and avoid
permanent damage to the tissues lining the nose and sinuses.

At first while being treated for acute or chronic
sinusitis, you may begin to feel better from antibiotics and home
treatment, but sometimes your symptoms become worse and additional treatment may be
needed.

For acute sinusitis

Short-term (acute) sinusitis
usually lasts less than 4 weeks. Up to two-thirds of people with acute
sinusitis improve on their own without antibiotic treatment.footnote 1 Sinus infections are commonly caused by
viral infections, which do not respond to antibiotics. Talking with
your doctor will help you determine whether treatment with
antibiotics is needed for your acute sinus infection.

Most people recover completely when treated with an antibiotic for acute
sinusitis that is caused by a bacterial infection. The number of days you take
antibiotics depends on the antibiotic and how bad the infection is. When
you are prescribed an antibiotic, be sure to take it until it is gone, even if
you feel better. Always take an antibiotic exactly as your doctor tells you, or the infection may not go away
completely.

For chronic sinusitis

Sinusitis that lasts 12 weeks
or longer is called chronic sinusitis. It is more difficult to treat and
responds more slowly to antibiotics than acute sinusitis.

Antibiotic therapy is usually recommended for chronic sinusitis and may
require a longer course of treatment. You may need to try more than one
antibiotic. A
corticosteroid nasal spray that reduces
inflammation and swelling of the lining of the nasal
passages may also be used during treatment.

In some people, a
sinus infection may be caused by a
fungus or a bacterium other than those normally
associated with sinusitis. People who have an
impaired immune system are at risk for these unusual
infections. It also may include people who must use an oral or inhaled
corticosteroid medicine (such as prednisone). Fungal sinusitis, which
accounts for a significant number of chronic sinusitis cases, does not respond
to antibiotic treatment and may need treatment with antifungal medicines,
corticosteroids, or surgery.

Surgery may be required if you have
taken antibiotics for an extended period of time but still have symptoms or
when complications (such as infection of facial bones) are
likely.

What to think about

Sinusitis may be difficult to
diagnose, because it often causes the same symptoms as a cold or other viral
illness, especially in its early stages. It can be particularly difficult to
identify sinusitis in children. If your child or you have frequent sinus
infections, learn what signs to watch for, and begin home treatment
immediately.

Symptoms of chronic sinusitis are often vague and may
not respond well to treatment. It may take time and patience to find a
successful treatment.

Prevention

There are several ways you may reduce your
chance of getting
sinusitis:

Treat stuffiness (nasal congestion) caused by
colds or allergies promptly. This can help you prevent a
bacterial infection from developing in your sinuses.

Avoid contact with people who have colds and other
viral upper respiratory infections. If you do have
contact with people who have these infections, wash your hands often ,
especially after being in contact with those who are
infected.

Avoid cigarette, cigar, and pipe smoke in your home and
workplace. Smoke causes and further irritates inflamed membranes in your nose
and sinuses.

If you have allergies, avoid the things that trigger
your allergy attacks. Consider talking to your doctor about
immunotherapy, such as allergy shots. For more information,
see the topic
Allergic Rhinitis .

Avoid breathing dry
air. Consider using a humidifier at home and work to increase the moisture in
the air.

Make sure your child gets all the recommended immunizations . Some
immunizations, such as pneumococcal conjugate
vaccine,
may help prevent ear and sinus infections.

Home Treatment

Home treatment may relieve symptoms of
pain and pressure associated with short-term (acute)
sinusitis. Home treatment may improve drainage of
mucus from the sinuses and prevent the need for
antibiotics.

Drink plenty of fluids to help keep your
mucus thin.

Apply moist heat (using a hot,
damp towel or gel pack) to your face for 5 to 10 minutes, several times a
day.

Breathe warm, moist air from a steamy shower, a hot bath, or a
sink filled with hot water. Avoid extremely cool, dry air. Consider using a
humidifier to increase the moisture in the air in your home.

Use
saltwater nasal washes (saline lavage or irrigation)
to help keep the nasal passages open and wash out mucus and bacteria. You can
purchase saline nose drops or sprays at a pharmacy or make your own saline solution at
home. If you make saline at home, use distilled water or water that has been boiled and then cooled. People who have postnasal drip and are around age 8 and older may also find it helpful to gargle often with warm salt water. This can help prevent a sore throat.

If you need to
blow your nose, do it gently. Forceful blowing may force thick mucus back into
your sinuses and block them. Keep both nostrils open when blowing your
nose.

Avoid alcohol. It causes swelling of the tissue lining the
nose and sinuses.

What to think about

If you are taking antibiotics
for a sinus infection, do not stop taking the antibiotics early just because
you feel better. Take the entire course of antibiotics. The infection may not
go away if you do not take all of the antibiotics prescribed by your doctor.

Antibiotic treatment is successful in most cases of
short-term (acute) sinusitis when it is caused by
bacteria. You should notice improvement within 3 to 4
days after you begin taking an antibiotic.

Chronic sinusitis may last 12 weeks or longer and usually
requires 3 to 4 weeks of antibiotic treatment. Symptoms may persist or return
despite adequate antibiotic treatment. A different antibiotic may be needed to
treat the infection. Referral to an ear, nose, and throat (ENT) specialist
(also called an
otolaryngologist) may be needed if symptoms of
sinusitis do not go away despite long-term antibiotic treatment.

A foreign object that is blocking a nasal or
sinus passage. This usually occurs in children.

Surgery may be the only means of getting a badly blocked,
infected sinus to drain properly. But surgery does not always completely
eliminate sinusitis. Some people may need a second operation.

Surgery is most successful when used along with medicine and home
treatment to prevent future sinusitis. A second surgery and future sinusitis
may be avoided if antibiotics are taken to prevent reinfection.

Surgery choices

Endoscopic surgery is preferred over traditional surgery
for most cases of chronic sinusitis that require surgery. It is less invasive,
less expensive, and has a lower rate of complications.

Endoscopic surgery may be done to remove small amounts
of bone or other material blocking the sinus openings or to remove growths
(polyps). Normally, a thin, lighted tool called an endoscope is inserted
through the nose so the doctor can see and remove whatever is blocking the
sinuses.

Sinus surgery may be done when
complications of sinusitis-such as the development of pus in a sinus, infection
of the facial bones, or brain
abscess-have occurred. In this type of surgery, the
doctor makes an opening into the sinus from inside the mouth or through the
skin of the face.

What to think about

Very few
people need surgery to treat sinusitis. But you may need surgery if
ALL of these are true:

Your doctor says that you have chronic
sinusitis.

You've followed what's called "maximum medical
treatment" for 4 to 6 weeks. This means that you've taken medicines and
followed home treatment for at least 4 to 6 weeks. This treatment includes
antibiotics, a
steroid nasal spray, and other prescription
medicines.

You've had a
CT scan of your sinuses after the 4 to 6 weeks of
treatment. It is very important to have the CT scan done after this treatment. Reducing the swelling and infection as
much as possible lets your doctor see what could be causing your
infections.

The CT scan shows that something, such as nasal polyps, is keeping your
sinuses from draining as they should.

You also may need surgery if:

You have a sinus infection caused by a
fungus. Infections caused by fungus cannot be cleared up with
antibiotics.

You have a serious problem such as an infection that
spreads beyond your sinuses. This is rare.

The extent of the blockage and other problems determine
how extensive your surgery will need to be. Surgery may be limited to removal
of infected tissue or small growths (polyps) inside the nose. More extensive
surgery involves removing pieces of bone to create a wider opening to allow a
sinus to drain.

Sinus surgery is always performed by an ear, nose,
and throat (ENT) specialist (also called an
otolaryngologist).

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